Resection of unusually large pseudoaneurysms of the aortic isthmus is complex, and involves various strategies of cardiopulmonary bypass (CPB), cerebral and spinal cord protection. We report on a patient with a giant pseudoaneurysm of the distal arch and proximal descending aorta, in whom cannulation of the femoral artery was unfeasible. Instead, the right axillary artery and the left femoral vein were cannulated. This technique allowed to perform a left anterolateral thoracotomy with the patient already on CPB and hypothermic, and to shorten the duration of hypothermic circulatory arrest.